First questions to ask
What kind of service is the complaint about?
Primary and community care
Primary and community care covers GPs (family doctors), nurses, health visitors, dentists, opticians, pharmacists, and a range of specialist therapists, such as physiotherapists, speech and language therapists, podiatrists, counsellors, occupational therapists and psychologists.
GPs, dentists, opticians and pharmacists are ‘independent practitioners’ who work for the NHS through national contracts, held and administered locally by Primary Care Trusts.
Primary Care Trusts (PCTs) are local health organisations responsible for managing local health services. They work with local authorities and other agencies that provide health and social care locally to make sure the community's needs are being met. PCTs are now at the centre of the NHS and get 75% of the NHS budget. Primary Care Trusts are responsible for planning secondary care.
Specialist mental health care is normally provided by Mental Health Trusts or local council social services departments. Services range from psychological therapy, through to very specialist medical and training services for people with severe mental health problems.
Other NHS Trusts also provide services in the community, such as patient transport (including accident and emergency ambulances), NHS Walk-In Centres, NHS Direct.
Secondary care
NHS Hospital Trusts, including NHS Foundation Trusts, provide mainly acute (short stay) services: medical, surgical, accident and emergency, outpatients, rehabilitation and maternity service, plus a range of specialist therapies: physiotherapy, speech and language therapy, podiatry and occupational therapy.
Foundation Trusts are a new type of NHS hospital run by local managers, staff and members of the public which are tailored to the needs of the local population. Foundation Trusts have been given much more financial and operational freedom than other NHS Trusts. These Trusts remain within the NHS and its performance inspection system. There are currently 25 NHS Foundation Trusts in existence with another 10 seeking to become NHS Foundation Trusts from 1 April 2005. The next wave of Foundation trusts will include, for the first time, 8 Mental Health Trusts.
Day hospitals provide services, such as chiropody and occupational therapy, for elderly or mentally ill people to help them continue to live in the community.
Some Trusts are regional centres for specialised care: plastic or neurosApril 18, 2006quo; centres of expertise: undertaking heart and liver transplants, eye and bone cancer treatments. Some are university teaching hospitals which train doctors, nurses and other health professionals and undertake research. Children's Hospitals are specialist centres with an environment designed especially for children's needs. Some rural areas have Community or local neighbourhood hospitals with fewer facilities. Many offer day surgery, outpatient clinics and maternity services.
Hospital Trusts usually have their own Departments of Psychiatry.
Health and social care
The term 'social care' covers a wide range of services, which are provided by local authorities and the independent sector.
Social care comes in many forms. Adults can be supported in the community through home care, sitting, meals and day services or through residential or nursing home care. Children and families are supported at home through a wide range of child protection, social work, early years and other services.
Health and Social care joint provision
The 1999 Health Act Partnership Arrangements allow closer working between health and local authorities. The key powers are being able to pool funds and delegate functions to enable integrated provision and lead commissioning.
The Health and Social Care Act 2001 builds on the aims of integrating health and local authority services for vulnerable people. It introduced a new policy for the formation of Care Trusts,(external link) which are new bodies, able to commission and/or provide health and other services, which can be better co-ordinated to meet the needs of the users. By combining both NHS responsibilities and local authority health responsibilities under a single management, care trusts can increase continuity of care and simplify administration. There are very few Care Trusts at the moment.
Continuing care
This refers to situations where a person's health needs are such that the NHS funds all their care in a nursing home or their own home. Health Authorities have local eligibility criteria which define the level of NHS care.
Following publication of a report on long term care (external link) in February 2003 by the NHS Ombudsman, the Department of Health requested all Strategic Health Authorities to establish an integrated set of eligibility criteria for NHS continuing health care to operate across each territory, and to undertake a process of retrospective review of cases where people may have been denied continuing care.
NHS-funded nursing care
The NHS employs nurses to deliver care needed by the vast majority of the population, whether in hospital, residential care or at home. Before October 2001, some people had to pay for their own nursing care. Now everyone in need, regardless of setting and means, is eligible for NHS-paid care from a registered nurse. This gets rid of the anomaly of people having to pay for care in a nursing home that would be provided free in residential accommodation or at home.
NHS funded nursing care: overview and information for the public (external link)
Next: What stage of the NHS Complaints procedure is appropriate?
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